the corpus cavernosum of the penis. It has to be noted that a positive result is found in patients with both normal and mild vascular disease; therefore, results have to be interpreted with caution. Duplex ultrasound of Penile Arteries measures blood flow in order to study penile vasculature in response to an injection of a vasoactive agent.19 Cavernosometry and cavernosography are highly specialized investigations that are performed only in specific circumstances, while arteriography ought to be performed when an arterial lesion has been found on Duplex Doppler evaluation. Cavernosometry is used to diagnose primary venous pathology in young men. Penile abnormalities such as phimosis, tight frenulum, and penile curvatures have to be treated surgically. Peyronie’s disease is discussed further below.

Treatment

Among the various treatment options which include medical, psychosocial, and surgical

treatment, it is important to carefully select the most suitable option based on the patient´s individual profile. Treatment modalities should be discussed with the patient and his partner and should be based on the patient´s risk factors and comorbidities after appropriate counseling of the patient.

Important“reversible”causes for ED including lifestyle factors such as obesity, cigarette smoking, alcoholism, or substance abuse have to be managed as well as psychosocial factors such as partner conflicts or any psychosexual dysfunctions. Modification in the comedication such as antihypertensive agents (particularly betablockers and diuretics), psychotropic drugs such as antidepressants and antiandrogens, steroids and antiarrhythmics might result in clinical benefits. In case of hypogonadism and hyperprolactinemia,hormone replacement therapy should be offered. However, patients need to be followed closely when receiving androgen therapy. Contraindications include abnormal liver function, hyperlipidemia, polycythemia, prostate cancer, aggressive behavior, and sleep apnea.